As pediatric mental health care grows more complex and the shortage of child mental health specialists worsens, achieving widespread adoption of innovative delivery models to promote high-quality mental health care in general pediatric settings becomes critically important. This Mentored Patient-Oriented Career Development (K23) Award will enable the candidate, a general pediatrician and health services researcher, to become an independent investigator in child mental health services research. Her long-term career goal is to develop expertise in designing, evaluating, and improving primary care-based innovations in mental health care, with a focus on maximizing broad physician adoption of innovations. With carefully-crafted projects, an experienced, deeply committed mentorship team, and a relevant training plan, she will achieve four key educational objectives: 1) to bolster quantitative and qualitative skills to determine patterns and correlates of adoption of health care innovations;2) to increase knowledge of and experience in child psychopathology;3) to understand core theoretical concepts in physician and organizational behavior as they relate to adoption of innovations and to place these concepts into a framework of mental health care delivery in pediatric primary care;4) to gain skills to design a trial to assess effects of modifying innovations on adoption in pediatric primary care. The first research goal is to conduct a mixed-methods study of adoption patterns and barriers to adoption for two underutilized innovations in child mental health. One innovation is the Massachusetts Child Psychiatry Access Program, a state-funded telephone consult program whereby pediatricians obtain phone consults from child mental health specialists while the patient is in the pediatrician's office. The second innovation is an ADHD electronic medical record template with clinical decision support, which prompts physicians to deliver guideline-adherent care during office visits. A second research goal is to develop a randomized controlled pilot study to assess feasibility of a larger trial to test if modifying the innovations to address identified barriers to adoption will increase adoption in real-world general pediatric settings. At the conclusion of the award, the candidate will have unique expertise and be well-prepared to carry out a research agenda to explore how innovations in health care delivery to support treatment of mental health conditions can be more effectively implemented in pediatric primary care. RELEVANCE (See instructions): Poor mental health care among youth is a public health problem. Understanding barriers to adoption of innovations that help diagnosis and treat mental health problems in pediatric primary care will lead to interventions that achieve broader adoption of these effective tools, which will increase the number of youth with mental health conditions who receive ongoing high-quality, effective treatment in primary care settings.